Address the effectiveness of the communication approach used by Corey or other professionals in the case study as well as the approach used to resolve the issue.Discussed the actions taken in response to the ethical dilemma presented in the case study and whether the approach was effective in solving the ethical dilemma. Please highlight in yellow the revision you make. THANKSCASE STUDY:Corey Davidson is the new Emergency Department Director at Crosby Community Hospital. When he was hired, the hospital administrator explained that the first order of business would be for Corey to develop a system for documenting the reappraisal process for physicians applying for reappointment to the medical staff and for clinical privileges. At the time of his interviews, Corey didn’t think much of this focus, but now that he has been on the job for several months, he realizes that there was a very specific reason: Dr. Lacey.Dr. Lacey has been practicing medicine in Crosby County longer than the hospital has existed, and has treated virtually everyone who works in the hospital. With his twinkly blue eyes and white hair, Dr. Lacey was Crosby’s very own Dr. Santa. Dr. Lacey’s reputation used to be unassailable, but unfortunately age and declining health are taking a toll on his skills. Complicating the situation is the fact that Dr. Lacey is seen as a beloved icon by anyone who didn’t actually work with him.When Corey logs onto his email one Monday morning, he finds a request to meet with Margaret Truman, Director of Nursing. When they meet, she wastes no time in explaining what she wants to discuss.“You’re going to have to do something about Dr. Lacey… or rather, Dr. Lasix, as the nursing staff are currently calling him”“What’s happened?” Corey asks, somewhat nervously.“Well, you know how we’ve been moving toward a more evidence– based approach to diagnosis and treatment in the ED” Margaret says. One of the areas where we’ve established some solid guidelines is regarding patients presenting with shortness of breath.”Corey nods. “Yes, I remember you presented on piloting the use of the guidelines.”“That’s just it — Dr. Lacey is completely unwilling to use them” Margaret says. We’ve come to terms with his unwillingness to use the electronic health record — that’s a battle we just weren’t going to win — but this is getting serious. He’s gotten it into his head that Lasix is the drug of choice for anyone who comes in with dyspnea. This goes against the guidelines we’ve assembled, but he won’t listen to a mere nurse — especially when he’s ordering meds for a patient.“The thing is — Lasix can be an effective treatment in some cases, but it isn’t recommended as the first treatment option for a patient who has been brought into the ED. There are a number of situations where Lasix can actually be harmful. If the patient has pneumonia or dehydration, they shouldn’t be given Lasix at all. The guidelines we established specifically call for delaying the use of Lasix until a definitive diagnosis of heart failure can be confirmed by chest Xray and laboratory studies.”A thought occurs to Corey. “Why are you coming to me today with this? Did something happen over the weekend?”“That’s exactly why I’m here,” says Margaret. “We had a patient present Saturday night with confusion and difficulty breathing. Dr. Lacey ordered Lasix and chest xrays, but the nurse assisting him suspected sepsis. The patient had come in from a nursing home and her skin was not in good shape. Sure enough, the patient had a particularly nasty pressure sore.“The problem is that Dr. Lacey will not listen to the nursing staff and his own skills are less than they used to be. In this case, the nurse was able to convince him to follow the guidelines, but honestly, nurses have their own work to do and it doesn’t include watching over a doctor to make sure he doesn’t actually harm anyone.”Corey nods, glumly aware that he is going to be the person who took away Dr. Santa’s ER privileges.
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OLD SCHOOL OR OUT OF TOUCH?
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Old School or Out of Touch?
Sarai Artires
Capella University
Developing a Health Care Perspective
Applying Ethical Principles
January 2019
OLD SCHOOL OR OUT OF TOUCH?
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Old School or Out of Touch?
As the years have gone by, evidence-based practice has progressed how we treat patients.
New concepts have been demonstrated to avoid complications, previously caused by medical
errors, medication administration, and steps in procedures. Meanwhile, everyone in the health
care field must adapt and learn any revision.
However, “Age is often associated with a decline in cognitive abilities that are important for
maintaining functional independence, such as learning new skills.” (Clark R, Freedberg M,
Hazeltine E, Voss MW, 2015). With that being said, we understand that, as we get older, the
capability of learning new approaches becomes uneasy after having the experience for so many
years. In this short story “Old School or Out of Touch?” Dr. Lacey has practiced many years
treating all his patients with symptomatic SOB with the same treatment (Lasix). Evidence-based
practice has proved that those interventions must be changed to ensure the life of the patients
better. The approach of treatment for shortness of breath is not always Lasix unless it has been
ruled out any cardiac congestion.
The conflict in this short story involves the decision making of Dr. Corey Davidson as the
new Emergency Department Director to take away the privileges of Dr. Lacey that has been
practicing medicine longer than the hospital even existed.
Director of Nursing, Margaret
Truman had acknowledged the need for an ethical decision regarding the common issue of
medication administration for SOB by Dr. Lacey. Once this ethical dilemma was recognized and
processed, including moral rights, cost-benefit, fairness or justice, a judgment of right or wrong
was analyzed to reach the ethical decision making this situation required certainly.
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Utilitarianism is among the most widely debated moral theories, in which the happiness
of the greatest number of people in society is considered the greatest good.
Actions are
considered morally right if it brings the greatest good to the greatest amount. In this case, Corey
Davidson has three choices; converse with Dr. Lacey about better methods of dealing with the
condition, talk to him about retirement, and omitting to act. Davidson’s main aim is to ensure
that patients are not put under any harm because of Dr. Lacey’s insistence to traditional methods.
Dr. Lacey is used to his old methods, and at her age, it would be hard for him to learn new
methods. He feels comfortable using her old method which is not bad, but it is harming the
patients — getting him to realize that he needs to won’t be easy. He may also feel like he is
being undermined if he is told that his methods don’t work and there is need for him to upgrade.
Retirement is the best option because it is easy and benefits a lot of people which includes the
patients that Dr. Lacey would have been handling and the nurses who would have had to recheck
Dr. Lacey’s treatment options to see whether they are up to standard.
When talking to Dr. Lacey, Davidson should not make Dr. Lacey feel incompetent but
rather talk about changes that have happened and the need for him to take a break from the
profession. Retirement will help the hospital because they will bring in a doctor who will treat
patients with modern methodologies which are more effective. It will also help Dr. Lacey
because he won’t have to deal with the pressure that comes with being a doctor and will have the
chance to relax and enjoy old age. Omitting to act in a situation like this will eventually bring
more readmissions due to the failure of patient treatment goal and even high mortality percent
rate of the hospital.
When trying to decide, based on most patients in comparison to staff, the right choice is
to remove the authority position from the hospital. A doctor can be immediately replaceable, but
OLD SCHOOL OR OUT OF TOUCH?
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a life cannot be brought back. It’s morally correct to take this action and discontinue the
privileges to cause harm by Dr. Lacey potentially. An approach like this needs to be assertive, in
a one to one discussion and respect the rights of an employee. “Understanding and appreciating
professional roles and responsibilities and communicating effectively emerged as the two
perceived core competencies for patient-centered collaborative practice.” (Suter, E. Role
understanding and effective communication as core competencies for collaborative practice,
2009).
Code of conduct, laws, and regulations need to be applied when confronting this
situation. This outcome will bring beneficence to most of our incoming patients. This will be
bringing confidence to patients regarding their stay at Crosby Community Hospital, as well as
security to other medical staff including nurses that won’t need to be supervising Dr. Lacey for
mistakes.
When talking to Dr. Lacey about his decision, Davidson should not make Dr. Lacey feel
incompetent. He should listen to him and try to understand his reasons for sticking with the
traditional methods. Afterward, he will talk to him about the advancements that have been done
in the field and why there is a need to change with the changing times. He will then introduce the
idea of retirement. He should appeal to his emotions and make him feel that the retirement was
his idea. The matter is a sensitive one, and there is a need to protect Dr. Lacey’s feelings from
hurt.
In conclusion, in the health care field, ethics is the most basic and important subject.
Health care professionals, encounter situations daily in which ethical judgment must be made
and actions must be taken. But with the four main principles of autonomy, beneficence, nonmaleficence, and justice, patients will be honored by their rights, and we can ensure a positive
outcome for our patients.
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References
Clark, Rachel. (2015). PLOS. Are There Age-Related Differences in the Ability to
Learn Configural Responses.
Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0137260.
Vermont Ethics Network. (2011). Health care ethics: Overview of the basics.
Retrieved from http://www.vtethicsnetwork.org/ethics.
Suter, Esther. (2009). Journal of Interprofessional Care. Role understanding and
Effective communication as core competencies for collaborative practice. Retrieved from
https://www.tandfonline.com/doi/abs.
Trevino, L. K., Nelson, K. A. (2007). Business ethics: Straight talk about how to do it right.

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